By understanding the individual and being able to shape the environment they need, we can help them to bring about positive change. Our residential care provision may be delivered in a communal living small home environment or in a number of individual flats that still afford an excellent level of relational security for the people that use the service.
Pro-Social Modelling (PSM) is an evidenced based psychotherapeutic intervention that is based on positive values and modelling and coaching principles. We apply PSM throughout the company and use many of it’s core evaluative tools to ensure our staff develop the correct attitudes towards understanding challenging behaviours. It encourages a transparent and open learning culture, and is completely compatible with Positive Behaviour Management (PBM).
Social Coaching is one of the methods we use to help not only our staff learn how, when and what to do, but also the individuals we provide a service for. Our Clinical Team members provide social coaching in the services and staff are able to learn by example. This ensures that good practice and therapeutic responses are transferred throughout the staff team.
We ensure that good attributions are developed and maintained as we know this is central to the caring experience the individual will have from our staff. This is particularly important when they engage in behaviours described as challenging. We therefore actively explore attributions as part of our training provision in PBM, and as an ongoing experience in any supervisions, direct observations and all relevant meetings.
Positive Behaviour Support (PBS) provides a framework that seeks to understand the context and meaning of behaviour in order to inform the development of supportive environments and skills that can enhance a person’s quality of life. We use PBS as the person-centred, values-based approach to ensure people are living the best life they possibly can. This involves assisting a person to develop personal relationships, improve their health, be more active in their community and to develop personally.
Please watch the following animation from BILD (British Institute of Learning Disabilities) that explains more about the PBS approach:
Behaviour support plans are informed by an assessment of a range of factors. As part of the plan we may create primary preventative strategies and secondary preventative strategies. Behaviour support plans include guidance as to how staff can support a person to reduce the likelihood of reaching ‘crisis’ or how best to support the person once in a ‘crisis’. This may include the use of secondary prevention and as a last resort restrictive interventions.
Primary preventative strategies aim to ensure that:
Secondary preventative strategies aim to promote relaxation and avert any further escalation to a crisis. These include:
These strategies are to be used by carers/staff when a person starts to become anxious, aroused or distressed.
We carry out skilled assessment in order to understand probable reasons why an individual presents behaviours of concern, what predicts their occurrence and what factors maintain and sustain them (this area of assessment is often referred to as a functional assessment). This requires consideration of a range of contextual factors including personal constitutional factors, mental and physical health, communication skills and the person’s ability to influence the world around them. Patterns of behaviour provide important data and a skilled analysis enables key areas of un-met need to be understood. In addition to the functional assessment, we are able to provide a psychologically informed formulation of the individual’s needs which draws upon different theories and empirically supported theoretical approaches.
These plans are drawn up by taking into account all past, present and future risks. We are fully aware that as well as static risk, there are also dynamic risk factors and these are likely to change over time as an individual changes. We therefore utilise an approach called scenario planning and where suitable use empirically proven risk assessment tools that include static risk tools and those classed as structured clinical judgement. Some of the tools we may use include the HCR-20 version 3 and the RSVP.
Whilst we are fully able to provide therapeutic interventions for individuals, we do not work in isolation as this would not be in the best interest of the individuals who use our services. We ensure that we collaborate with external agencies, including local CLDTs, CMHTs, purchasing authorities and Transforming Care Partnerships (where appropriate). This collaboration ensures that we are all clear about the outcomes, the pathway, the risks and the contingency plans if required.
As a professional social care service, our strengths are that we can maximise outcomes by providing therapeutically driven interactions throughout the 24 hour period. Our consultation and social coaching of direct line staff is therefore the main focus of our work and this is where we are able to provide the greatest impact from our professional backgrounds.